STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED
Charges are only for those items that you selected or that are required. If we are required by law or by a cemetery or crematory to use any items, we will explain the reasons in writing below.
I. PROFESSIONAL SERVICES | |
Basic Services of Funeral Director and Staff | $ |
Embalming (including use of preparation room and sanitary care) | |
If you selected a funeral that may require embalming, such as a | |
funeral with viewing, you may have to pay for embalming. You do | |
not have to pay for embalming you did not approve if you | |
selected arrangements such as a direct cremation or immediate | |
burial. If we charged for embalming, we will explain why below. | |
Other preparation of the body | $ |
Other (specify) | |
Professional Services TOTAL | $ |
II. OTHER STAFF AND RELATED FACILITIES | |
Use of facilities and staff for: | |
Visitation (viewing) | $ |
Funeral Ceremony | |
Memorial Service | |
Use of Equipment and Staff for: | |
Graveside Service (including accompaniment of remains to | |
place of final disposition) | |
Other (specify) | |
Other Staff and Related Facilities TOTAL | $ |
Transfer of Remains to Funeral Home | $ |
Hearse | |
Limousine | |
Other (specify) | |
Transportation TOTAL | $ |
OPTIONAL PACKAGED SERVICES | |
1. Direct Cremation | $ |
2. Immediate Burial | |
3. Forwarding Remains | |
4. Receiving Remains | |
|(If you select an optional package, see General Price List for a | |
|list of included services.) | |
Optional Packaged Services TOTAL | $ |
IV. MERCHANDISE | $ |
Casket or Alternative Container: | |
Manufacturer | |
Model | |
Type of material | |
Interior material | $ |
Vault/Outer Burial Container: | |
Manufacturer | |
Model | |
Type of material | |
Other (specify) | |
Merchandise TOTAL | $ |
FUNERAL HOME CHARGES TOTAL (I-IV & Packaged Services) | $ |
V. CASH DISBURSEMENTS (Estimated) | |
Disposition: State permit and filing fees | $ |
Certified copies of death certificate #____ @ $ _____ | |
Cemetery or crematory | |
Officiant and/or place of worship | |
Music (specify) | |
Obituary charges | |
Other cash disbursements (specify) | |
Cash disbursements TOTAL | $ |
TOTAL OF ESTIMATED CHARGES (I-V & packaged services) | $ |
GRAND TOTAL OF ESTIMATED CHARGES | $ |
IF ANY LAW, cemetery or crematory requirements have required the purchase of any of the items listed above, the law or requirement is described below:
...
Relationship to Decedent
Street Address
City, State, Zip Code
N.J. Admin. Code § 13:36-1.9